The Effects of a Self-Efficacy Enhancement Program Combined with Social Support via the LINE Application on Self-Care Behaviors among Cervical Cancer Patients Receiving Radiotherapy at the National Cancer Institute
Keywords:
cervical cancer, radiotherapy, self-care, self-efficacy, social support, LINE applicationAbstract
This study aimed to evaluate the effects of a self-efficacy enhancement program combined with social support through the LINE application on self-care behaviors among cervical cancer patients receiving radiotherapy at the National Cancer Institute of Thailand. A quasi-experimental one-group pretest-posttest design was employed. The sample consisted of 34 cervical cancer patients in stages II–III who underwent radiotherapy between December 16, 2024 and August 30, 2025. The intervention included a self-efficacy enhancement and social support program delivered via LINE. Data were collected using questionnaires with established content validity (IOC = 0.78) and reliability (α = 0.73). Descriptive statistics and Dependent t-tests were used for data analysis at a significance level of 0.05. The results showed a significant increase in self-efficacy scores after the intervention (p < 0.001). Social support scores also improved significantly (p < 0.005), and self-care behavior scores increased significantly (p < 0.001). Participants expressed high satisfaction with the program, with 92.5% satisfied with program content and participation, and 82.4% satisfied with overall benefits. These findings suggest that integrating self-efficacy enhancement with social support via a digital platform can effectively promote self-care behaviors, reduce potential treatment-related complications, and improve the quality of life among cervical cancer patients. This program has potential for implementation in radiotherapy services and could be expanded to other healthcare settings to strengthen patient self-management.
References
Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021;155(Suppl 1):28–44.
World Health Organization (WHO). Cervical cancer [Internet]. 2023 [cited 2023 Oct 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
National Cancer Institute. Hospital-based cancer registry 2021 [Internet]. 2021 [cited 2024 Oct 12]. Available from: https://nci.go.th/e_book/hosbased_2564/index.html
Chichareon S, Herrero R, Muñoz N, Bosch FX, Jacobs MV, Deacon J, et al. Risk factors for cervical cancer in Thailand: a case-control study. J Natl Cancer Inst. 1998;90:50–7.
Chino J, Annunzita CM, Beriwal S, Bradfield L, et al. Radiation therapy for cervical cancer: executive summary of an ASTRO clinical practice guideline. Clin Pract Guidel. 2020;10(4):220–34.
Wongpratate M, Bumrungthai S. Cervical cancer in Thailand: 2023 update. Obstet Gynecol Sci. 2024;67(3):261–9.
World Health Organization (WHO). Cervical Cancer Elimination Initiative [Internet]. 2022 [cited 2023 Oct 1]. Available from: https://www.who.int/initiatives/cervical-cancer-elimination-initiative
Burmeister CA, Khan SF, Schafer G, Mbatani N, et al. Cervical cancer therapies: current challenges and future perspectives. Tumour Virus Res. 2022;13(200238):e1–13.
Johnson C, James D, Marzan A, Armaos M. Cervical cancer: an overview of pathophysiology and management. Oncol Nurs. 2019;12(1):12–8.
Wang K, Tepper JE. Radiation therapy-associated toxicity: etiology, management, and prevention. Cancer J Clin. 2021;71(3):25–32.
Moreno-Acosta P. Biomarkers of resistance to radiation therapy: a prospective study in cervical carcinoma. Radiat Oncol. 2017;12:35–42.
Stake-Nilsson K, Gustafsson S, Tödt K, Fransson P, Efverman A. A study of self-care practice in routine radiotherapy care: identifying differences between practitioners and non-practitioners in sociodemographic, clinical, functional, and quality-of-life-related characteristics. Integr Cancer Ther. 2022;16:1–13.
อรดี ชูพันธ์ุ. ผลของการประยุกต์การพยาบาลระบบสนับสนุนและให้ความรู้ต่อการดูแลตนเองของผู้ป่วยมะเร็งปากมดลูกที่ได้รับรังสีรักษา [วิทยานิพนธ์ปริญญาวิทยาศาสตรมหาบัณฑิต (สาธารณสุขศาสตร์)]. กรุงเทพมหานคร: บัณฑิตวิทยาลัย มหาวิทยาลัยมหิดล; 2544.
Orem DE, Taylor SG, Renpenning KM. Nursing: Concepts of practice. 6th ed. St. Louis: Mosby; 2001.
Söderhamn O. Phenomenological perspectives on self-care in aging. Clin Interv Aging. 2013;8:605–8.
Haase KR, Sattar S, Hall S, et al. Systematic review of self-management interventions for older adults with cancer. Psychooncology. 2021;30:989–1008.
Koshy B, Avudaiappan SL, Anand AS. Self-care behaviour of patients with breast cancer in the management of side effects of chemotherapy. Cureus. 2023;15(9):e44589.
Wu F, Howell D, Fang Q, Chen J, Yuan C. Trajectory patterns and factors influencing self-management behaviors in Chinese patients with breast cancer. Cancer Nurs. 2020;43:e105–12.
Sivakumar VP, Susila C. Effectiveness of self-care measures on knowledge, self-efficacy and performance status among cancer patients. J Caring Sci. 2021;10(1):1–8.
Yasemin Yıldırım Usta. Importance of social support in cancer patients. Asian Pac J Cancer Prev. 2012;13:3569–72.
Rakhshani T, Najafi S, Javady F, Taghian Dasht Bozorg A, Mohammadkhah F, Khani Jeihooni A. The effect of Orem-based self-care education on improving self-care ability of patients undergoing chemotherapy: a randomized clinical trial. BMC Cancer. 2022;22(770):e10.1186/s12885-022-09881-x.
Bentsen L, Hanghøj S, Hjerming M, Bergmann MB, Thycosen M, Borup A, et al. Development of quality of life in adolescents and young adults with cancer using a patient support smartphone app: pre-post interventional study. JMIR Cancer. 2023;9:e49735.
Abd El Fatah NA, El Messiery MS, Awade AR. Effect of mobile-based educational program through WhatsApp on self-efficacy and psychological distress among female geriatric patients with breast cancer undergoing chemotherapy. Int Egypt J Nurs Sci Res. 2023;4(1):328–51.
Kardosod A, Bawornthip P, Conlon L. Effectiveness of self-management eHealth intervention for psychological adjustment for health-related quality of life in cancer survivors: a systematic review. Pac Rim Int J Nurs Res. 2023;27(2):351–67.
Yunis R, Fonda SJ, Aghaee S, Kubo A, Davis SW, Liu R, et al. Mobile app activity engagement by cancer patients and their caregivers informs remote monitoring. Sci Rep. 2024;14(1):3375.
Derksen ME, Jaspers MWM, Kunst AE, Fransen MP. Usage of digital, social and goal-setting functionalities to support health behavior change: a mixed methods study among disadvantaged women during or after pregnancy and their healthcare professionals. Int J Med Inform. 2023;170:104981.
งานรังสีรักษา. รายงานการบริการรังสีรักษา สถาบันมะเร็งแห่งชาติ. กรุงเทพมหานคร: สถาบันมะเร็งแห่งชาติ; 2567.
Chow SC, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research. 3rd ed. New York: Chapman and Hall/CRC; 2017.
Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.
Cobb S. Social support as a moderator of life stress. Psychosom Med. 1976;38(5):300–14.
Chitpin S, Wang C. Developing and validating an instrument for teacher decision-making. Int J Educ Methodol. 2021;7(3):503–17.
Liu H, Zhang X, Li F. The role of self-efficacy in self-management behaviors among head and neck cancer patients undergoing radiotherapy: a randomized controlled trial. J Cancer Educ. 2023;38(2):398–406.
Wang S, Zhang Q, Yu Y. Psychosocial support and self-efficacy interventions improve self-care and quality of life in radiotherapy patients. Psychooncology. 2021;30(4):564–72.
Chen Y, Liu L, Chen X, Wang J. Effects of a self-efficacy enhancement program on self-care behaviors among breast cancer patients undergoing radiotherapy. Support Care Cancer. 2022;30(5):4371–8.
Zhao Y, Liu X, Zhang Q. Association between self-efficacy and self-care behavior among cancer patients receiving radiotherapy: a cross-sectional study. Asia Pac J Oncol Nurs. 2020;7(3):296–302.
Zhang Q, Li X, Zhou Y. Group-based self-care intervention with social support improves self-management behaviors and psychological outcomes in cervical cancer patients. J Cancer Educ. 2023;38(1):145–52.
Kim J, Lee E, Park S. The effect of mindfulness and social support on self-efficacy and self-care behaviors in cancer patients receiving radiotherapy. Eur J Oncol Nurs. 2021;52:e101980.
Ma Z, Hou Y, Li T, Ji J, Lu S, Zhang Y, Sun W. Web-based symptom monitoring program for patients receiving radiation therapy: a prospective feasibility study. J Med Internet Res. 2022;24(7):e36872.
